| NPI | 1922355288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P20209) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022290) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2022-01-25 |