| NPI | 1922263805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 27002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07348) |
| 225100000X Physical Therapist (Licence: NC 12476) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2018-06-14 |