| NPI | 1427648542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: CA 299674) |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2024-06-17 |