| NPI | 1871910653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 15083) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0013910) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NC P14717) | |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2018-08-24 |