| NPI | 1780980979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 36452) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070024277) |
| 225100000X Physical Therapist (Licence: MD 23529) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2024-11-29 |