| NPI | 1861891897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-32815) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT20336) |
| 225100000X Physical Therapist (Licence: FL 20336) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT302035) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT20336) | |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2025-04-05 |