| NPI | 1174702062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18894) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: MD 18894) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 18894) | |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2012-09-17 |