| NPI | 1386163855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT36604) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 2000015008) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2022-03-17 |