| NPI | 1528808334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1390204) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2677) |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-05-29 |