| NPI | 1871175810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10578) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: SC 10578) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NC CP043007T) | |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2025-10-21 |