| NPI | 1720394760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 6268) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6268) |
| 225100000X Physical Therapist (Licence: NC 12762) | |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2021-02-05 |