| NPI | 1659988996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 36234) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36234) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT36234) | |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2021-02-07 |