| NPI | 1639579949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05009659A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36001544A) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2014-08-25 |