| NPI | 1952641565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT27501) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 14132) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2020-08-25 |