| NPI | 1275576456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL PT19637) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT19637) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT19637) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-09-11 |