| NPI | 1194980771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH10283) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2062) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NV 2062) | |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-07-27 |