| NPI | 1003011107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT25476) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: NC 10901) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2010-10-14 |