| NPI | 1144434176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 787) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: IA 1151) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |