| NPI | 1669678389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11893) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070024248) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096004915) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2024-02-20 |