| NPI | 1811066087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 13017) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: KS 3591) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2019-12-16 |