| NPI | 1790860203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21816) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 022788) |
| 225100000X Physical Therapist (Licence: NY 022788) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 022788) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-10-30 |