| NPI | 1023037389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12298619-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 5687) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-08-12 |