| NPI | 1235861964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11405499-2401) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: UT 114054992401) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2023-06-07 |