| NPI | 1275429086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NE 4827) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 225100000X Physical Therapist | |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-17 |