| NPI | 1831667179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CO PTL.0014750) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2018-11-05 |