| NPI | 1093184822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1270748) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2025-05-08 |