| NPI | 1790451219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29531) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT029699) |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-08-18 |