| NPI | 1942515176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NE 3463) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 537) |
| 225100000X Physical Therapist | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NE 3463) | |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2024-05-04 |