| NPI | 1700971322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: TX 1156286) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TN 7287) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 947) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2013-02-10 |