| NPI | 1881875714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT16219) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: FL PT16219) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2019-06-28 |