| NPI | 1295949022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK PT2525) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: OK PT2525) |
| 2251N0400X Physical Therapist, Neurology (Licence: OK PT2525) | |
| 2251S0007X Physical Therapist, Sports (Licence: OK PT2525) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: OK PT2525) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |