| NPI | 1629353396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: DC PT871467) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034175) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305207337) | |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2013-04-12 |