| NPI | 1194121350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: UT 9602025-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3065) |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2024-09-19 |