| 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 |