| NPI | 1114980877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: DE J10000429) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: DE J10000429) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: DE J10000429) | |
| 225100000X Physical Therapist (Licence: DE J10000429) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: DE J3-0000041) | |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2014-06-20 |