| NPI | 1013382654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3867) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1263500) |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2018-09-20 |