| NPI | 1427672740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05013728A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36003318A) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2020-06-02 |