| NPI | 1063769271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PTT32639) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: FL AL3168) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2022-07-21 |