| NPI | 1013317585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9432901-2401) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 9432901-4810) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2020-06-17 |