| NPI | 1235907502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1390954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 41159) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-04-08 |