| NPI | 1699337188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PA PT030460) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NY 101381-01) |
| 225100000X Physical Therapist (Licence: CA 300440) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2022-10-12 |