| NPI | 1235289133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 2208MT) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MT 2208MT) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2009-05-01 |