| NPI | 1417109810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MD 22764) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD T-6410) |
| 2251S0007X Physical Therapist, Sports (Licence: DC PT871627) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 22764) | |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2022-01-06 |