| NPI | 1235561697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT28541) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 28541) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2020-01-27 |