| NPI | 1972820199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P14641) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23236) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2026-08-28 |