| NPI | 1356335848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT17622) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: FL PT17622) |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2007-07-13 |