| NPI | 1982338398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4911) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NV 4911) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NV 4911) | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2022-07-13 |