| NPI | 1801318043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: VA 2305211549) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070022222) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2020-12-02 |