| NPI | 1285889600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IL 096-002645) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2023-12-01 |