| NPI | 1083112312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1396674) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2134786) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2024-10-15 |