| NPI | 1245710847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: OR 61193) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 61193) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2018-08-14 |