| NPI | 1548244908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 2487) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10819) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2026-04-13 |