| NPI | 1043468515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: TX 1032357) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX AT0961) |
| 2251X0800X Physical Therapist Orthopedic (Licence: TX 1032357) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2020-07-27 |