| NPI | 1487036844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OK 4951) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT4020) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-04-30 |