| NPI | 1942988266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT40386) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL PTT40386) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PTT40386) | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2023-08-09 |