| NPI | 1710920798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 14299) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1138303) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-02-01 |