| NPI | 1134283674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19018) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MD 19018) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2024-01-22 |