| NPI | 1891131322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P16950) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 08544) |
| Enumeration Date | 2013-05-10 |
| Last Update Date | 2020-10-11 |