| NPI | 1891705620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 06695) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: LA 06695) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2022-07-21 |