| NPI | 1710326376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2009019317) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MO 2009019317) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2009019317) | |
| 2251E1300X Physical Therapist, Electrophysiology, Clinical (Licence: MO 2009019317) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2015-03-26 |