| NPI | 1245410323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1301027) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MS PTA3890) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2023-03-09 |