| NPI | 1013431584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 007189) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2026-03-13 |