| NPI | 1053861666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0013435) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61816) |
| 225100000X Physical Therapist (Licence: CO 0013435) | |
| 225100000X Physical Therapist (Licence: WV 003501) | |
| 225100000X Physical Therapist (Licence: TN 0000010852) | |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2022-10-03 |