| NPI | 1487154035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19470) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 294510) | |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2026-07-01 |