| NPI | 1972857712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MS PT1042) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MS 1042) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2012-11-01 |