NPI | 1598723843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL PT 18038) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 18038) |
2251X0800X Physical Therapist, Orthopedic (Licence: FL PT 18038) | |
Enumeration Date | 2006-05-03 |
Last Update Date | 2014-01-23 |