| NPI | 1346478914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8449268-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2233) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2020-01-28 |