| NPI | 1316350838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3606) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0012676) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2017-04-11 |