| NPI | 1770747750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX 1181556) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2025-01-31 |