| NPI | 1679931125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1269786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL pt30707) |
| 225100000X Physical Therapist (Licence: SC 7940) | |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |