| NPI | 1417073875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 11466) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 29738) |
| 225100000X Physical Therapist (Licence: VA 2305207917) | |
| 225100000X Physical Therapist (Licence: CO 9739) | |
| 225100000X Physical Therapist (Licence: IA 04029) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: UT 11466) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 00515) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 4253) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2020-02-10 |