| NPI | 1720566474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 10938166-2401) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 2000033438) |
| Enumeration Date | 2018-08-04 |
| Last Update Date | 2024-08-20 |