| NPI | 1992188767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT28785) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: FL PT28785) |
| 2251G0304X Physical Therapist Geriatrics (Licence: FL PT28785) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: FL PT28785) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2018-11-06 |