| NPI | 1184124372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: FL PT38613) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL7618) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT38613) | |
| Enumeration Date | 2018-02-14 |
| Last Update Date | 2025-10-22 |