| NPI | 1194098517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PT60112) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2012004495) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2019-04-25 |