| NPI | 1073646170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251H1200X Physical Therapist, Hand (Licence: MO 103313) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 103313) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MO 103313) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2024-11-08 |