| NPI | 1164593299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 004109) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 004109) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2019-08-21 |