| NPI | 1386336337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 65794) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 5131) |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2025-08-19 |