| NPI | 1356999163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 34947) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT-34947) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2023-03-13 |