| NPI | 1194479717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: SC 11107) |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2025-06-12 |