| NPI | 1538364724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26572) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305205034) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2021-10-13 |