| NPI | 1598391492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AK 183475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 4004) |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-05-07 |