| NPI | 1548831399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC CP042511T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 31834) |
| 225100000X Physical Therapist (Licence: CO CP033607T) | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2025-03-06 |