| NPI | 1073115382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-3572) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 2251C2600X Physical Therapist, Cardiopulmonary | |
| 2251G0304X Physical Therapist, Geriatrics | |
| 2251P0200X Physical Therapist, Pediatrics | |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2020-12-03 |