| NPI | 1871210757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 24621) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 18609) |
| Enumeration Date | 2022-10-21 |
| Last Update Date | 2022-12-12 |