| NPI | 1407807597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 10483) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7221) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2025-11-18 |