| NPI | 1073743829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18707) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MD 18707) |
| 2251H1200X Physical Therapist, Hand (Licence: MD 18707) | |
| 2251S0007X Physical Therapist, Sports (Licence: MD 18707) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 18707) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2024-08-21 |