| NPI | 1164691697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: IA 004196) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NE 2408) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2008-10-08 |