| NPI | 1477301760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT CP031348T) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: TX 1391661) |
| Enumeration Date | 2024-05-10 |
| Last Update Date | 2024-07-09 |