| NPI | 1578666863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 9918-24) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2021-09-13 |