| NPI | 1043080625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 224P00000X Prosthetist |
| 225200000X Physical Therapy Assistant | |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-01-04 |