| NPI | 1306941364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL 23468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5073) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-08-23 |