| NPI | 1427448711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1329744) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0383541) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2021-05-17 |