| NPI | 1245586817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: AZ LPT-31803) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034474) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2021-12-28 |