| NPI | 1699082412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 12812) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26390) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2012-09-01 |