| NPI | 1629864632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist Neurology (Licence: FL PT33833) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT33833) |
| 2251X0800X Physical Therapist Orthopedic (Licence: FL PT33833) | |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2025-04-16 |