| NPI | 1982093134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: CA 43538) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NY 038580-1) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2018-11-27 |