| NPI | 1699833061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31411) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2031) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2016-08-04 |