| NPI | 1447642954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16937) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 120602624) |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2021-09-07 |