| NPI | 1467967828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: SD 1947) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2018-03-17 |