| NPI | 1962724500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NC P21520) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: VA 2305206238) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2025-12-17 |