| NPI | 1811426356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4676) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 0014912) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2020-08-10 |