| NPI | 1487214540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT34664) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT34664) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT34664) | |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2025-01-06 |