| NPI | 1083135008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2017022197) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 55541) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2025-06-23 |