| NPI | 1538776489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CA 308415) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: AZ Lpt-31440) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2026-06-02 |