| NPI | 1336499839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL PT 27504) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT39257) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2013-01-03 |