| NPI | 1811160674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT11101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA GA006263) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2008-04-11 |