| NPI | 1154324077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 8042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 001132) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2020-08-03 |