| NPI | 1962771857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 4212) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004933) |
| 225100000X Physical Therapist (Licence: IL 070018983) | |
| 225100000X Physical Therapist (Licence: AZ 10973) | |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2025-04-22 |