| NPI | 1831627074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 09642) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2022-07-21 |