| NPI | 1780292730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10292) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 10292) |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2025-01-23 |