| NPI | 1740661743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 22970) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 22970) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2015-06-16 |