| NPI | 1174602031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT23292) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 008374) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2015-10-21 |