| NPI | 1760825848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MO 2012027772) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2018-11-06 |