| NPI | 1134211600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL pt27820) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007613) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2024-11-20 |