| NPI | 1649480591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: MT 1216) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: MT 1216) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |