| NPI | 1235310871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16677) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 9608) |
| 225100000X Physical Therapist (Licence: OR 61793) | |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2016-12-27 |