| NPI | 1447690201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT 3581) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AR PT3581) |
| 2251S0007X Physical Therapist, Sports (Licence: AR PT3581) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-02-06 |