| NPI | 1396855805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK PT2323) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 27808) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-10-30 |