| NPI | 1174535645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 2442) |
| 224L00000X Pedorthist | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2015-06-30 |