| NPI | 1043541170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 39517) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH5836) |
| 225100000X Physical Therapist (Licence: TX 1194262) | |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2016-08-11 |