| NPI | 1649611534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 1737) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ND 1737) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2021-09-10 |