| NPI | 1376822163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MD 19933) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic (Licence: DC 870066) | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2024-04-02 |