| NPI | 1659579449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 9841) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8544) |
| 225100000X Physical Therapist (Licence: MS PT 4136) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2018-04-25 |