| NPI | 1609319425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA 294765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22713) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2018-07-02 |