| NPI | 1619011152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 036958) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 33468) |
| 225100000X Physical Therapist (Licence: WA PT60046366) | |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2019-12-26 |