| NPI | 1053756882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: ID PT-3152) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-3152) | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2021-07-24 |