| NPI | 1750610291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT10035) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 886064500) |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2009-12-11 |