| NPI | 1124784236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28744) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MD 28744) |
| 2251S0007X Physical Therapist, Sports (Licence: MD 28744) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MD 28744) | |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2021-11-12 |