| NPI | 1922158484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT0013467) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| 2251S0007X Physical Therapist, Sports (Licence: PT13467) | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-06-22 |