| NPI | 1346567104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 2315PT) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MT 51ATR) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2011-02-01 |