| NPI | 1003036351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1315748) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 015564) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2021-05-25 |