| NPI | 1467807149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1304607) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TX 2119871) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2023-02-07 |