| NPI | 1720810310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P22679) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL pt33176) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2024-08-16 |