| NPI | 1861068850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX 1346391) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1346391) | |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2021-06-01 |