| NPI | 1689454233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 10939) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 40895) |
| 225100000X Physical Therapist (Licence: LA 10939) | |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2023-10-02 |