| NPI | 1417358508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX 6240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 829) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2024-01-12 |