| NPI | 1114355054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 27369) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL 27369) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL 27369) | |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2013-10-30 |