| NPI | 1407300742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 13386-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2019046296) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2022-01-14 |