| NPI | 1255354809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1390979) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT12029) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2024-06-19 |