| NPI | 1942337159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 008954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 8954) |
| 225000000X Orthotic Fitter | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2019-09-17 |