| NPI | 1972383024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant |
| Additional Taxonomies | 226300000X Kinesiotherapist |
| 224Y00000X Clinical Exercise Physiologist | |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2023-10-04 |