| NPI | 1336760529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: IA 122358) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251S0007X Physical Therapist, Sports (Licence: IL 070023071) | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2025-08-28 |