| NPI | 1306290119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: KS 11-06605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2020-09-16 |