| NPI | 1063925204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1135382) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: TX 1135382) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2017-11-09 |