| NPI | 1538280698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT010906) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1356) |
| 225100000X Physical Therapist (Licence: MA 20091) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2013-11-22 |