| NPI | 1841386380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT39389) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 8254) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2025-10-06 |