| NPI | 1619733649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: AL PTH11733) |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2024-04-03 |