| NPI | 1487953923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 008078) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1184532) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2022-01-03 |