| NPI | 1467104687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL 39768) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: ME PT6026) |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2023-01-04 |