| NPI | 1336135284 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD 21182)  | 
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2005-09-26 | 
| Last Update Date | 2025-01-07 |