| NPI | 1922717420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT39695) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT39695.) |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2024-06-28 |