| NPI | 1114969961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: DC 871829) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 6446) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-08-13 |