| NPI | 1700361078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT-2023-2375) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT33717) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2024-09-30 |