| NPI | 1396384574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT5645) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC CP000555T) |
| 225100000X Physical Therapist (Licence: TX 1323496) | |
| Enumeration Date | 2020-01-05 |
| Last Update Date | 2020-01-05 |