| NPI | 1699816314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11627-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 11627-24) |
| 2251S0007X Physical Therapist, Sports (Licence: WI 11627-24) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2016-01-06 |