| NPI | 1689076671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15155) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC 15155) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2017-07-27 |