| NPI | 1427566710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 14609) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2018-01-20 |
| Last Update Date | 2025-04-26 |