NPI | 1417017500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT6617) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT6617) |
Enumeration Date | 2006-12-11 |
Last Update Date | 2016-07-21 |