| NPI | 1437761129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: KY 008217) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013891A) |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2024-10-11 |