| NPI | 1336171974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: GA PT009889) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK PT 3754) |
| 225100000X Physical Therapist (Licence: GA PT009889) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: SC 5975) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-08-19 |