| NPI | 1619452745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics |
| 2251G0304X Physical Therapist, Geriatrics | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2018-09-25 |