| NPI | 1134528409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: AZ 31001) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9677) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2019-12-18 |