| NPI | 1588115216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL 2-1312) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1986) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2024-01-05 |