| NPI | 1174508154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 48617222401) |
| Additional Taxonomies | 2251E1200X Physical Therapist Ergonomics (Licence: UT 48617222401) |
| 2251X0800X Physical Therapist Orthopedic (Licence: UT 48617222401) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2020-09-09 |