| NPI | 1144205139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2008-03-19 |