| NPI | 1649842139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CT 013715) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 014160-1) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-09-25 |