| NPI | 1730270216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: TN 0000006796) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA 008199) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 0000000825) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA 001039) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2013-12-19 |