| NPI | 1023279080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25392) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 008333) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2018-08-08 |