| NPI | 1639439763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1222580) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034194) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2024-07-17 |