| NPI | 1093271835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: AL PTH9290) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 9290) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2022-08-31 |