| NPI | 1235279662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT16788) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PT16788) |
| 225100000X Physical Therapist (Licence: FL 16788) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL 16788) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2024-10-14 |