| NPI | 1952030009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21773) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P20242) |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2025-03-11 |