| NPI | 1861470395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NM 2608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1173508) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2013-06-26 |