| NPI | 1770221459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15782) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 15782-24) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2023-05-10 |