| NPI | 1750320172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT23874) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 04438) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT23874) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2025-05-15 |