| NPI | 1689657264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: SC 2102) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: SC 2102) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: SC 2102) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2025-09-11 |