| NPI | 1588767479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 683) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: MT 683) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: MT 683) | |
| 2251N0400X Physical Therapist, Neurology (Licence: MT 683) | |
| 2251S0007X Physical Therapist, Sports (Licence: MT 683) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MT 683) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-11-10 |