| NPI | 1750615290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 24940) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18566) |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2009-10-01 |