| NPI | 1760581623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 04393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 04393) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2016-02-23 |