| NPI | 1205392750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NC 18533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P18533) |
| 2251S0007X Physical Therapist Sports (Licence: NC 18533) | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2024-02-28 |