| NPI | 1639390370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070017748) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1103850) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2008004998) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 2400609) | |
| 225100000X Physical Therapist (Licence: MO 2008020470) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2010-08-04 |