| NPI | 1790952315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025506-1) |
| 225100000X Physical Therapist (Licence: MD 20239) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2013-02-12 |