NPI | 1174065296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT321120) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 32120) |
Enumeration Date | 2016-11-07 |
Last Update Date | 2020-01-28 |