| NPI | 1740229376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: AZ 7188) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: AZ 7188) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2007-07-08 |