| NPI | 1831546993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 19248) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P19248) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2022-01-13 |