| NPI | 1659851152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16538) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2021-04-05 |