| NPI | 1306860671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026488) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 000605) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NV 0506266) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-08-09 |