| NPI | 1861692261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2007011443) |
| Additional Taxonomies | 2251H1300X Physical Therapist, Human Factors |
| 2251N0400X Physical Therapist, Neurology | |
| 2251P0200X Physical Therapist, Pediatrics | |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2009-03-03 |