| NPI | 1992571285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: MD 29712) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MD 29712) |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2023-11-28 |