| NPI | 1053361030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PT.0012732) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-3663) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501017657) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AK 1213) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT60476692) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2017-03-15 |