| NPI | 1396732715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 41475) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 012611) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2015-11-19 |