| NPI | 1376701250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: OR 5623) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: OR 5623) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2009-10-05 |