| NPI | 1023416989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 25287) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT024126) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2016-02-09 |