| NPI | 1124882410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: NM PTA1706) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NM PTA1706) |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-02-08 |