NPI | 1790810240 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 20316) |
Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT 20316) |
Enumeration Date | 2007-02-23 |
Last Update Date | 2014-08-13 |