NPI | 1902340235 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT 32190) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT32190) |
Enumeration Date | 2016-12-06 |
Last Update Date | 2021-04-20 |