| NPI | 1891015749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT25109) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031467) |
| 225100000X Physical Therapist (Licence: FL PT 25109) | |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2024-04-29 |