| NPI | 1265612501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1339245) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027020) |
| Enumeration Date | 2007-11-04 |
| Last Update Date | 2024-09-09 |