| NPI | 1174882542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P12653) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT27234) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2012-11-15 |