| NPI | 1376704072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MT 1348) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: MT 1348) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2014-10-17 |