| NPI | 1144225517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 3849) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MN 7122) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2013-04-15 |