| NPI | 1891007480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 27937) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: TX 1197078) | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2013-01-15 |