| NPI | 1750809448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL PT34062) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: VA 1679719421) |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2021-06-09 |