| NPI | 1508075334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NC 18323) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 029027-1) |
| 2251S0007X Physical Therapist, Sports (Licence: NJ 40QA01368400) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-09-20 |