| NPI | 1770926271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: HI 5017) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 28105) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2020-10-15 |