| NPI | 1265873186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14145) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 14145) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2024-02-22 |