| NPI | 1831544543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1170024) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 11700) |
| Enumeration Date | 2016-05-01 |
| Last Update Date | 2024-05-01 |