| NPI | 1457884421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: SC 8497) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11382) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2020-07-14 |