| NPI | 1700291242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 3983) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 29364) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2024-09-06 |