| NPI | 1558409284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 7700) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT 7700) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |