| NPI | 1225675721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT40328) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 009662) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-08-07 |