| NPI | 1639793953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-6769) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-6769) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2026-02-27 |