| NPI | 1346302817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AR PT 3550) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 3967) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2013-03-28 |