| NPI | 1275753790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: WA 60311427) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist (Licence: ACSM-RCEP 1004531) |
| 225100000X Physical Therapist (Licence: AK PHY 2314) | |
| 225100000X Physical Therapist (Licence: FL PT 26410) | |
| 225100000X Physical Therapist (Licence: WA PT60311427) | |
| 225100000X Physical Therapist (Licence: CA PT301553) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: FL AL 1836) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-08-03 |