| NPI | 1710901152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1231280) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: AZ 3616) |
| 2251S0007X Physical Therapist, Sports (Licence: AZ 3616) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2019-10-01 |