| NPI | 1013237718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61656) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 2318PT) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2021-02-04 |