| NPI | 1083161442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 10658R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5247) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2023-03-15 |