| NPI | 1851790570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60726) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2025-01-21 |