| NPI | 1871025767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KS 94-11926) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT8023) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2024-06-13 |