NPI | 1811203706 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WI 66097-20) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11468) |
Enumeration Date | 2010-08-30 |
Last Update Date | 2019-09-20 |