| NPI | 1992126296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32298) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 40831) |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2018-07-17 |