| NPI | 1679213607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA CP038862T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 008558) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-32127) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-01-13 |