| NPI | 1720436066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1086940) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2022-01-21 |