| NPI | 1821145368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK OK940) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: OK 190) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-10 |