| NPI | 1366792715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1407002) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.018866) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2025-10-29 |