| NPI | 1720075302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11142) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05006961A) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: SC 6969) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2015-06-17 |