| NPI | 1265948616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37819) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MD A0001035) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2021-09-16 |