| NPI | 1730187030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 16283) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305203943) |
| 225100000X Physical Therapist (Licence: AZ 11085) | |
| 225100000X Physical Therapist (Licence: NM 4488) | |
| 2251S0007X Physical Therapist, Sports (Licence: VA 2305203943) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2018-02-14 |