| NPI | 1346045945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KY 009059) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 40883) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1380498) | |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-02-17 |