| NPI | 1770747750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 225100000X Physical Therapist (Licence: NC P12659) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2025-12-10 |