| NPI | 1245210970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 16224) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: MD 16224) |
| 2251H1200X Physical Therapist, Hand (Licence: MD 16224) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2015-01-07 |