| NPI | 1740412873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 8914) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT24938) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2010-09-27 |