| NPI | 1528407871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NE 3110) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1267170) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2024-09-19 |