| NPI | 1033413158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-25182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT26142) |
| 2251X0800X Physical Therapist Orthopedic (Licence: FL PT26142) | |
| Enumeration Date | 2011-01-04 |
| Last Update Date | 2024-02-07 |