| NPI | 1144651258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7440) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 10648) |
| Enumeration Date | 2013-11-29 |
| Last Update Date | 2014-07-16 |