| NPI | 1457527681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1148181) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012083) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2023-10-24 |