| NPI | 1457587206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2013038162) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2013037334) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2022-08-19 |