| NPI | 1780010652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ LPT-13746) |
| Additional Taxonomies | 174400000X Specialist (Licence: KS 11-04706) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2026-07-07 |