| NPI | 1295265171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1372257) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CA 51391) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 2000027143) | |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-02-05 |