| NPI | 1891737755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03097) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: IA 03097) |
| 2251S0007X Physical Therapist Sports (Licence: IA 03097) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: IA 03097) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-04-03 |