| NPI | 1306115621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 30815) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209874) |
| 225100000X Physical Therapist (Licence: NY 031785) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT30815) | |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2021-12-23 |