| NPI | 1427488584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27566) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CO PTL.0013689) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO AT.0001478) | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2022-07-21 |