| NPI | 1952658833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NC P15362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1221156) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2017-01-27 |