| NPI | 1639808777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA CP026485T) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MS 7329) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2023-12-12 |