| NPI | 1093195950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7664) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 1-0774) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: GA PT015562) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2024-10-21 |