| NPI | 1912413436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO CP02591T) |
| 225100000X Physical Therapist (Licence: GA 009392) | |
| 225100000X Physical Therapist (Licence: AZ CP032616T) | |
| 225100000X Physical Therapist (Licence: HI 4477) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 294189) | |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2026-04-08 |