| NPI | 1306874227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 003846) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: CT 003846) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CT 003846) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 116) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-08 |