| NPI | 1700972874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251E1300X Physical Therapist, Electrophysiology, Clinical |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2008-07-24 |