| NPI | 1093122657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2014012518) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AR AR 2243) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2014-07-16 |