| NPI | 1679952295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 25517) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209401) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2024-04-02 |