| NPI | 1508939463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 5959) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16201) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2011-10-13 |