| NPI | 1790043719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT27324) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27324) |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2016-02-04 |