| NPI | 1780898023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305204989) |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2014-06-09 |