| NPI | 1336241793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1140507) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: TX 1140507) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2017-12-20 |