| NPI | 1134119076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT22480) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT22480) |
| 225100000X Physical Therapist (Licence: IL 070012903) | |
| Enumeration Date | 2005-10-23 |
| Last Update Date | 2025-12-05 |