| NPI | 1891275962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT33946) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: FL PT33946) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT33964) | |
| Enumeration Date | 2018-08-18 |
| Last Update Date | 2018-09-04 |