| NPI | 1619051315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MS PT1396) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: LA PT 1132) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |