| NPI | 1699530311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216296) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007100) |
| 225100000X Physical Therapist (Licence: MN 12136) | |
| 225100000X Physical Therapist (Licence: FL 34454) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KY 1078) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 3378) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 5548) | |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-02-21 |