| NPI | 1508821109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5436) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT5605) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2015-11-05 |