| NPI | 1548656341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1340142) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 9248990-2401) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2021-04-19 |