| NPI | 1457437527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: ND 1085) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NE 1200) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2010-07-27 |