| NPI | 1487081493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34598) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WV PT003225) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2019-06-04 |