| NPI | 1245611276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: ID PT-4218) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-4218) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2021-04-16 |