| NPI | 1649635970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1261339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11965) |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2024-11-05 |