| NPI | 1558928986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14614) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 1461424) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2025-07-17 |