| NPI | 1316195209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0639) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: SD 0639) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2016-10-05 |