| NPI | 1861725657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: HI PT 3116) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38041) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2019-03-19 |