| NPI | 1760617492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT0014585) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: CP003601) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2009-05-26 |