| NPI | 1366762122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12290) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6218) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-2773) | |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2024-05-02 |