| NPI | 1952848483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT017502) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NC P23387) | |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2024-12-04 |