| NPI | 1992297907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P23678) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 11065) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT36962) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2026-01-23 |