| NPI | 1306130703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-2424) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2019-05-15 |