| NPI | 1366619413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 8629) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 4908) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2021-12-08 |