| NPI | 1336133560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6677) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NM 2133) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2018-03-17 |