| NPI | 1407995533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT12014) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251E1200X Physical Therapist, Ergonomics | |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2017-05-20 |