| NPI | 1992502264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: SC 11904) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: SC 11904) |
| 2251S0007X Physical Therapist, Sports (Licence: SC 11904) | |
| Enumeration Date | 2025-02-25 |
| Last Update Date | 2025-02-25 |