| NPI | 1124700778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD CP039875T) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305215592) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2025-01-28 |