| NPI | 1598051500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 07940) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23638) |
| 225100000X Physical Therapist (Licence: FL 31317) | |
| 225100000X Physical Therapist (Licence: NC CP006278T) | |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2025-01-30 |