| NPI | 1225537228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 5867) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK CP004023T) |
| 225100000X Physical Therapist (Licence: TX 1301339) | |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2022-07-28 |