| NPI | 1588871446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT25224) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: IN PT25224) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2015-10-06 |