| NPI | 1467017558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX CP032416T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02220600) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2019-05-05 |
| Last Update Date | 2025-02-03 |