| NPI | 1366869737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10145) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1293532) |
| 225100000X Physical Therapist (Licence: FL PT35951) | |
| 225100000X Physical Therapist | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2020-12-01 |