| NPI | 1700015245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT26202) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TX 1189163) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2011-02-14 |