| NPI | 1497480792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT39007) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MD 29148) | |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2023-06-07 |