| NPI | 1265630818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 62625) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-5566) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: UT 6588519-2401) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2018-05-09 |