| NPI | 1437824745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT42251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 2105) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2025-05-14 |