| NPI | 1639570336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL PT29558) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT359558) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2026-02-12 |