| NPI | 1518599877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT35572) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: WI 14903-24) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2020-03-23 |