| NPI | 1659315703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22685) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305202490) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 8447) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2024-08-21 |