| NPI | 1922188911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NC P10129) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P10129) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2022-03-21 |