| NPI | 1932316940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2011037087) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT2966) |
| 2251S0007X Physical Therapist, Sports (Licence: AR PT2966) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AR PT2966) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: 2011037087) | |
| 2251S0007X Physical Therapist, Sports (Licence: 2011037087) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2013-10-29 |