| NPI | 1235786641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 10296) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2019-08-22 |