| NPI | 1336267913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 2927) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT23824) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2015-07-09 |