| NPI | 1548747397 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT20082) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: FL PRO132) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2018-07-24 |