| NPI | 1457929994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1351187) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TX 1351187) |
| 225100000X Physical Therapist (Licence: TX 3126891) | |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-08-23 |