| NPI | 1548217607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 22943) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 22943) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2022-01-20 |