| NPI | 1073539193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 4260) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: SC 4260) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: SC 4260) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2016-02-29 |