| NPI | 1336376599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2128) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NE 2128) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NE 2128) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2019-12-04 |