| NPI | 1770516734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 18588) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 36493) | |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2022-09-23 |