| NPI | 1386638401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 1923) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 1387) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2007-07-08 |