| NPI | 1326696311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1294378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP000664T) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2022-10-07 |