| NPI | 1124174065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 10794) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60510979) |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NC 10794) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-12-09 |