| NPI | 1740584002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 9252PT) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 5823) |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2015-05-06 |