| NPI | 1225551567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 9069084-2401) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 9069084-4810) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2021-12-03 |