| NPI | 1710294269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT37335) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070.017907) |
| Enumeration Date | 2010-09-04 |
| Last Update Date | 2023-03-08 |