| NPI | 1851957575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28508) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9581) |
| 2251S0007X Physical Therapist, Sports (Licence: MD 28508) | |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2024-12-23 |