| NPI | 1588183776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT34547) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2019-12-12 |