| NPI | 1407580301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC CP034958T) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2024-09-26 |