| NPI | 1073585386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007742) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 5831) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2009-09-14 |