| NPI | 1437692571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL PT 32087) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 32087) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2016-11-21 |