| NPI | 1730855214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214596) |
| 2251X0800X Physical Therapist, Orthopedic | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305214596) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2024-02-23 |