| NPI | 1952979940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300719) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000022656) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-09-09 |