| NPI | 1891031274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT30281) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035665) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2015-10-21 |