| NPI | 1699840884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT9908) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PT9908) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2018-05-22 |