| NPI | 1104302298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NC P23364) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: SC 11288) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 27017) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2024-08-06 |