| NPI | 1962432690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MA 17706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH4256) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2017-03-26 |