| NPI | 1861926800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P16495) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2025-02-07 |