| NPI | 1184080939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MD 27469) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: DC PT871990) |
| 2251S0007X Physical Therapist, Sports (Licence: VA 2305214837) | |
| Enumeration Date | 2016-01-09 |
| Last Update Date | 2024-09-04 |