| NPI | 1447659552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: GA PT015362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60665607) |
| 2251S0007X Physical Therapist, Sports (Licence: NC P15096) | |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2023-02-20 |