| NPI | 1104345206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 08020r) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: LA 08020R) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2022-07-21 |