| NPI | 1861862542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| 2251N0400X Physical Therapist, Neurology | |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2022-07-21 |