| NPI | 1053936138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MS 6889) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: MS 6889) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2020-06-15 |