| NPI | 1639423353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1223971) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1223971) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2023-04-27 |