| NPI | 1770571085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 135) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: SD 135) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2007-07-08 |