| NPI | 1457327207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05007539A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 3600945A) |
| 225100000X Physical Therapist (Licence: IL 070-019026) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2015-06-17 |