| NPI | 1851394977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 3301) |
| 2251H1200X Physical Therapist, Hand (Licence: SC 3301) | |
| 2251N0400X Physical Therapist, Neurology (Licence: SC 3301) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: SC 3301) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 399) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-04-02 |