| NPI | 1609008903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 05277R) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: LA ATH.J00349) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2009-08-25 |