| NPI | 1821199324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21473) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: DE J10001993) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-06-15 |