| NPI | 1225537848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 17041-24) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 2649-19) |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2025-01-06 |