| NPI | 1295191914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 61184) |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2023-12-01 |