| NPI | 1558311035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 6125) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 15079) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2010-04-13 |