| NPI | 1922526193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 13548) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 837-19) |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2026-08-28 |