| NPI | 1912199621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MD 15623) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NH 4809) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2021-10-06 |