| NPI | 1194226100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1233058) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT3820) |
| Enumeration Date | 2018-02-24 |
| Last Update Date | 2022-05-23 |