| NPI | 1972585560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: 915917) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: 915917) |
| 225X00000X Occupational Therapist (Licence: 915917) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2007-07-08 |