| NPI | 1033527767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-5246) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports |
| 2251X0800X Physical Therapist Orthopedic | |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2022-05-10 |