| NPI | 1013439413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1299438) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1299438) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-08-10 |