| NPI | 1063942092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT26981) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT26981) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2022-01-21 |