| NPI | 1366965238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NM PT5449) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3744) |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2024-10-30 |