| NPI | 1265982771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11680864-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 6312) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2024-01-29 |