| NPI | 1932626348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1385549) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: TX 2000052675) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2023-11-05 |