| NPI | 1952368417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: HI 3617) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AK 2584) |
| 225100000X Physical Therapist (Licence: TX 1152461) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2023-08-07 |