| NPI | 1053661785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9536) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: CT 9536) |
| 2251N0400X Physical Therapist, Neurology (Licence: CT 9536) | |
| 2251S0007X Physical Therapist, Sports (Licence: CT 9536) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CT 9536) | |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2012-09-10 |