| NPI | 1871084392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NC P18050) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9129) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2025-04-23 |