| NPI | 1629341698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NC 13370) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13370) |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2024-09-26 |