| NPI | 1962664854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 26347) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3764) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2011-11-02 |