| NPI | 1447351374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: TN PT0000005953) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: TN PT0000005953) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TN AT0000000464) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-06-03 |