| NPI | 1154373702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT3352) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ID PT-3352) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT3352) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2024-05-04 |