| NPI | 1871168070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT36606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 36606) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-08-12 |