| NPI | 1720223696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA pt019619) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019619) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2024-09-03 |