| NPI | 1326184847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2005034881) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT012128L) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1164650) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-04-26 |