| NPI | 1972985075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 30402) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 230520373) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2015-06-24 |