| NPI | 1417323833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 27095) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 11736) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2018-08-15 |