| NPI | 1326324674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1309995) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA 60123594) |
| 225700000X Massage Therapist (Licence: TX 120231) | |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2022-10-13 |