| NPI | 1306283023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT31489) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 04011R) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2022-06-10 |