| NPI | 1629221106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11798) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P11798) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CO 10356) | |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2020-08-12 |