| NPI | 1891701488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 32949) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 2156) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA 106) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2010-05-24 |