| NPI | 1992761761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA LA03237) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: LA LA03237) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: LA LA03237) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: LA LA03237) | |
| 2251S0007X Physical Therapist, Sports (Licence: LA LA03237) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2017-03-16 |