| NPI | 1528066883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT4367) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MD 17822) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 17822) | |
| 2251E1200X Physical Therapist, Ergonomics (Licence: MD 17822) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2021-06-10 |