| NPI | 1073884771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 6955200-4810) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2016-09-13 |