| NPI | 1407595093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214339) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2023-11-03 |