| NPI | 1699402149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 302166) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10337) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 511128) | |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2022-08-04 |