| NPI | 1952969909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: WI 14719-24) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: WI 14719-24) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2022-02-22 |