| NPI | 1861436131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2251N0400X Physical Therapist Neurology (Licence: FL PT21281) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT21281) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-08 |