NPI | 1336514009 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT31170) |
Additional Taxonomies | 225100000X Physical Therapist |
2251S0007X Physical Therapist, Sports (Licence: FL PT31170) | |
Enumeration Date | 2015-12-07 |
Last Update Date | 2023-05-25 |