| NPI | 1487786810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21437) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MD 21437) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-06-06 |