| NPI | 1104309103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AK 229862) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1293472) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2025-02-14 |