| NPI | 1043036791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42568) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: FL PT42568) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: FL PT42568) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT42568) | |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2024-12-02 |