| NPI | 1285901025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 37679) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033010) |
| 225100000X Physical Therapist (Licence: TX 1200661) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2024-04-20 |