| NPI | 1578321030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1381567) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 40745) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-07-02 |