| NPI | 1902936073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P21033) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT14272) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2023-05-19 |