| NPI | 1326339052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17268) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| 2251X0800X Physical Therapist, Orthopedic | |
| 225100000X Physical Therapist (Licence: AZ 9278) | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2024-02-29 |