| NPI | 1013997139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: GA 002536) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: GA 002536) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2024-06-13 |