| NPI | 1619494325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 113914) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 13182) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2025-07-16 |