| NPI | 1497905236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1160093) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT008301L) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2021-05-11 |