| NPI | 1851683270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 000643) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2011-05-03 |