| NPI | 1659406379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TN 2449) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: GA 4934) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN 227) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2015-05-20 |