| NPI | 1114055498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 2657) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 2657) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2023-02-23 |