| NPI | 1669296836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P23894) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049146) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2025-03-04 |