| NPI | 1104230846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: IA 074146) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2015018854) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2020-04-30 |