| NPI | 1457686909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 49) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: IA 49) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2009-10-15 |