| NPI | 1952360836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 1584) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: SD 0825) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-09 |