| NPI | 1215223599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT CP019061T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033714-1) |
| 225700000X Massage Therapist (Licence: TX MT108859) | |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2023-07-20 |