| NPI | 1740605609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26293) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020970) |
| 225100000X Physical Therapist (Licence: CT 008797) | |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2014-03-13 |