| NPI | 1093427569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22541) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 12467) |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2025-04-30 |