| NPI | 1902573074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7615) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-7615) | |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-11-04 |