| NPI | 1568451151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 15140) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 7746) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2019-04-24 |