| NPI | 1639897267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1394452) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL 39229) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2024-08-12 |