| NPI | 1831329440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT21158) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01069) |
| 225100000X Physical Therapist (Licence: PA PT000322E) | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2009-07-16 |