| NPI | 1396638359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: LA 11471) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: LA 11471) |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-05-29 |