| NPI | 1164504114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22872) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MT P22872) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2024-05-29 |