| NPI | 1003012980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2143) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 2143) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2022-07-06 |