| NPI | 1023423407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 31010) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 08798) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2015-12-04 |