| NPI | 1427335322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16125) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NC 1890) |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2025-02-19 |