| NPI | 1962465526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-2056) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2003028226) |
| 225100000X Physical Therapist (Licence: ID PT-2056) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2023-08-03 |