| NPI | 1568856029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20242) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: SC 7669) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2021-06-22 |