| NPI | 1518942291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 348508-2401) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: UT 348508-2401) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: UT 348508-2401) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2023-07-26 |