| NPI | 1073695771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT26669) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT26669) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2025-09-11 |