| NPI | 1104237189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: TX 1278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1144657) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: 1144657) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: 1144657) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-05-13 |