| NPI | 1649873472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 15076-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0017116) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2026-07-14 |