NPI | 1154683894 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27379) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT27379) |
Enumeration Date | 2012-06-08 |
Last Update Date | 2019-07-30 |