| NPI | 1023332186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 31108) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CO 11540) |
| 2251X0800X Physical Therapist Orthopedic (Licence: AZ 31108) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: AZ 8656) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ 0651) | |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2022-07-25 |