| NPI | 1538723564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MS PT4504) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: MS PT4504) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2019-04-25 |