| NPI | 1609921329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CO 18506) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1170588) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2022-08-15 |