| NPI | 1417622986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1352028) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1352028) |
| 225100000X Physical Therapist (Licence: TX 3127700) | |
| 2251S0007X Physical Therapist, Sports (Licence: TX 3127700) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 3127700) | |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2023-01-20 |