| NPI | 1962417675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 23527) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21730) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2009-07-20 |