| NPI | 1598749376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH 1820) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5136) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2024-05-08 |