| NPI | 1609400688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298206) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 35555) |
| 146N00000X Emergency Medical Technician, Basic (Licence: FL 554022) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 3532) | |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2024-01-02 |