| NPI | 1235263591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: DE J1-0002660) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07164) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2011-01-10 |