| NPI | 1821201922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OH 011269) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NE 2409) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |