| NPI | 1740683366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 28743) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 06866) |
| Enumeration Date | 2014-09-28 |
| Last Update Date | 2014-09-28 |