| NPI | 1639251242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: HI 5519) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 6994) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-12-30 |