| NPI | 1467548222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CO 0012571) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 2251) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2025-07-02 |