| NPI | 1881981132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 6714) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 24792) |
| 2251S0007X Physical Therapist, Sports (Licence: IN 05006810A) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MA 18005) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-07-07 |