| NPI | 1104090364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 003325) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL 003325) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2008-04-18 |