| NPI | 1073947933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1234176) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 3113552) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2024-07-22 |