| NPI | 1538846068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1365711) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO MSPTL.0000016) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2023-06-27 |