| NPI | 1497275754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1296362) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist Orthopedic (Licence: TX 1296362) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-21 |