| NPI | 1225662943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10144) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P19366) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2025-10-27 |