| NPI | 1326148263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 7708) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT3432) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 1258) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-07-17 |