| NPI | 1831112796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT10512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 020122) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-12-20 |