| NPI | 1710096698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT16802) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6674) |
| 225100000X Physical Therapist (Licence: IN 05008321A) | |
| 225100000X Physical Therapist (Licence: TX 1158677) | |
| 225100000X Physical Therapist (Licence: SC 4992) | |
| 225100000X Physical Therapist (Licence: NC 9940) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |