| NPI | 1104062348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P-CP006289T) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 37362) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0016686) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2025-01-06 |