| NPI | 1184635369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 006094) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: CT 006094) |
| 2251S0007X Physical Therapist, Sports (Licence: CT 006094) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CT 006094) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2019-05-03 |