| NPI | 1790852028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: DC PT870757) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23839) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2012-11-01 |