| NPI | 1780910158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14605) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15668) |
| 101YP2500X Counselor, Professional (Licence: WI 4654) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WI 1460524) | |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2019-08-22 |