| NPI | 1568231611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NC P22826) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NC P22826) |
| Enumeration Date | 2023-12-29 |
| Last Update Date | 2024-01-02 |