| NPI | 1114029816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: PA PT008977L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002229) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2013-08-05 |