| NPI | 1720254220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18681) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P18681) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2025-06-11 |