| NPI | 1215054663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: HI PT-1939) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: HI MAT-9599) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2023-12-23 |