| NPI | 1063256998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1380909) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: AZ LPT-033373) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-08-21 |