| NPI | 1245004555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P23578) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 40859) |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2024-11-20 |