| NPI | 1558532481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: OR 3872) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3872) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2021-07-22 |