| NPI | 1700335510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT4013) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292008) |
| 225100000X Physical Therapist (Licence: FL 34013) | |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2025-02-27 |