| NPI | 1548621691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 225100000X Physical Therapist (Licence: OK 4677) | |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2024-11-06 |