| NPI | 1730589755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: SC 7519) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7519) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2021-11-29 |