| NPI | 1518122654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2008025212) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MO 2008025212) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2008025212) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: MO 2008025212) | |
| 2251S0007X Physical Therapist, Sports (Licence: MO 2008025212) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2008-08-20 |