| NPI | 1407027352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OR 62605) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62605) |
| 2251S0007X Physical Therapist, Sports (Licence: CO 5136) | |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2020-04-13 |