| NPI | 1487022638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics |
| 2251P0200X Physical Therapist Pediatrics | |
| 2251S0007X Physical Therapist Sports | |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2015-09-04 |