| NPI | 1568980068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8917198-2401) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: UT 8917198-4810) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2024-08-07 |