| NPI | 1346554508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 8993) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: UT 7678682-2401) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2010-07-29 |