| NPI | 1790889343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: FL PT15056) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0014581) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2017-02-15 |