| NPI | 1104631951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH12172) |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-08-13 |