| NPI | 1740796994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NV 4437) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NV 4437) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 294086) | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2025-07-22 |