| NPI | 1104069913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1249361) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT35353) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2020-11-20 |