| NPI | 1740709559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05015449A) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IN 06005059A) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36002941A) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2024-05-31 |