| NPI | 1265595714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: HI 2995) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870557) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2014-02-11 |