| NPI | 1720336340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6769) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 490) |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AL PTH6769) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2019-07-30 |