| NPI | 1144774605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30581) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1279903) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2019-08-20 |