| NPI | 1720256308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P15053) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: NC 2451) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2016-05-10 |