| NPI | 1184070633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: TX 1274755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1274755) |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2019-03-27 |