NPI | 1982713400 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT32725) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT25605) |
225100000X Physical Therapist (Licence: MD 21922) | |
225100000X Physical Therapist (Licence: CO 11056) | |
Enumeration Date | 2006-08-29 |
Last Update Date | 2018-04-30 |