| NPI | 1386219830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TN 12451) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TN 12451) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-05-26 |