| NPI | 1205036415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 5161-024) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT 28264) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: IL 070-014463) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: IN 05004602A) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2007-07-25 |