| NPI | 1982655882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 1529PT) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MT 1529PT) |
| 2251S0007X Physical Therapist, Sports (Licence: MT 1529PT) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-12-11 |