| NPI | 1295293652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT-34078) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT-34078) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: ID PT6215) | |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2021-06-28 |