| NPI | 1588057418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 7679) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 26964) |
| Enumeration Date | 2015-03-17 |
| Last Update Date | 2015-03-17 |