| NPI | 1568830719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT30787) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT30787) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2026-03-02 |