| NPI | 1922465947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH7676) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7876) |
| 225100000X Physical Therapist (Licence: MS 5903) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2019-06-19 |