| NPI | 1720464514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11705) |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2022-02-11 |