| NPI | 1780282244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT35897) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT35897) |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2023-01-13 |