| NPI | 1871732115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Y00000X Clinical Exercise Physiologist |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225400000X Rehabilitation Practitioner (Licence: LA CEP.CE0117) | |
| 225500000X Specialist/Technologist (Licence: LA CEP.CE0117) | |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2023-01-31 |