| NPI | 1659394203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05005935A) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IN 36000933A) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-10-30 |