| NPI | 1497415731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1357064) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1357064) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT8549) | |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2022-08-18 |