| NPI | 1508191560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305210108) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT24546) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2023-12-19 |