| NPI | 1174647770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT17949) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT17949) |
| 2251S0007X Physical Therapist Sports (Licence: FL PT17949) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2010-11-16 |