| NPI | 1699266007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 22) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2025-04-16 |