| NPI | 1487680450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251H1200X Physical Therapist, Hand (Licence: DC PT2916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT2916) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: DC PT2916) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-10-01 |