| NPI | 1477524635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251E1300X Physical Therapist Electrophysiology, Clinical (Licence: CA 41) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 11437) |
| 2251S0007X Physical Therapist Sports | |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2009-08-19 |