| NPI | 1699052571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 60059) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO 11345) |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2018-08-01 |