| NPI | 1174799266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 733) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: MT 733) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-05-08 |