| NPI | 1174181887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1393401) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-5506) |
| 225100000X Physical Therapist (Licence: NC P22646) | |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2024-06-04 |