| NPI | 1467942326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27679) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2021-10-11 |