| NPI | 1902472772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: IL 070.025799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.025799) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2023-08-24 |