| NPI | 1457509986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1185920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34276) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2024-05-12 |