| NPI | 1366189656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P21256) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P21256) |
| 2251S0007X Physical Therapist, Sports (Licence: NC P21256) | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2022-05-18 |