| NPI | 1679065395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: MD 27924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27924) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2020-07-06 |