| NPI | 1922072610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: IN 05006565A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36000529A) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-07-08 |