| NPI | 1063865699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16769) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 3095297-8016) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2025-01-15 |