| NPI | 1801872247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 2301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 2301) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2018-04-25 |