| NPI | 1598190787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60917750) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2251S0007X Physical Therapist, Sports (Licence: NY 040612) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2021-05-24 |