| NPI | 1124042106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1219312) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC30938) |
| 111NS0005X Chiropractor, Sports Physician (Licence: TX 8575) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-07-21 |