| NPI | 1891814547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: SC 4050) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NC 9254) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2009-06-11 |