| NPI | 1700553138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20752) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NC P20752) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NC P20752) | |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2025-01-09 |