| NPI | 1568924348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37213) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214533) |
| 225100000X Physical Therapist (Licence: KY 008502) | |
| 225100000X Physical Therapist (Licence: SC 10947) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL4563) | |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2022-04-06 |