| NPI | 1033849229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1393345) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 11274) |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2024-06-05 |