| NPI | 1801995774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 39526) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TN PT0000007746) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-05-03 |