| NPI | 1386202919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC CPO32832T) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 28157) |
| 225100000X Physical Therapist (Licence: MA 24220) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2024-10-02 |