| NPI | 1720718927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 29023) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-06-20 |