| NPI | 1669624573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA PT00614) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2011-10-20 |