| NPI | 1922535731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| 2251S0007X Physical Therapist, Sports | |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |