| NPI | 1902340235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT 32190) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT32190) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2021-04-20 |