| NPI | 1114465887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1280307) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 118384) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2022-03-31 |