| 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 |