| NPI | 1922750512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CO 0018175) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2023-02-03 |