| NPI | 1730320755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1108744) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00562300) |
| 225100000X Physical Therapist (Licence: FL PT13055) | |
| Enumeration Date | 2009-03-21 |
| Last Update Date | 2009-03-21 |