| NPI | 1881025716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 9984) |
| 225100000X Physical Therapist (Licence: AL PTH6925) | |
| 225100000X Physical Therapist (Licence: TX 1241363) | |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2014-04-03 |