| NPI | 1396362208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 4500) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 295494) |
| Enumeration Date | 2020-06-26 |
| Last Update Date | 2022-10-13 |