| NPI | 1023520608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0018537) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1351491) |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2024-03-13 |