| NPI | 1487798427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: AK 225) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 225) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-10-12 |