| NPI | 1588954663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1200459) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006037) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2024-03-26 |