| NPI | 1457723868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT5651) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: FL PT5651) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: FL PT5651) | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2015-10-25 |
| Last Update Date | 2026-02-13 |