| NPI | 1447497797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 2447) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AK PHYP2447) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2025-10-29 |