| NPI | 1386954931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH CP032980T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023971) |
| 225100000X Physical Therapist (Licence: VA 2305208891) | |
| 225100000X Physical Therapist (Licence: NY 038226) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002545) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT005488) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2024-08-09 |