| NPI | 1417108762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60353079) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 62-025598) |
| 2251S0007X Physical Therapist, Sports (Licence: NY 62-025598) | |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2013-06-14 |