| NPI | 1669083507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1335294) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP015157T) |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2024-03-10 |