| NPI | 1902320856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 28283) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 28283) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 3513) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2025-02-10 |