| NPI | 1366287930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: Pending) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 41805) |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2024-07-16 |