NPI | 1053505586 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT0000000) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5571) |
225100000X Physical Therapist (Licence: CO 9632) | |
Enumeration Date | 2007-08-28 |
Last Update Date | 2015-03-25 |