| NPI | 1265985709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1239715) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH7389) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2016-08-02 |