| NPI | 1083650360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT 24202) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008304) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2013-03-14 |